@layout("/common/_form.html",{js:["/assets/cms/contactUs/contactUs_edit.js"],plugins:["ue"]}){

<form class="layui-form" id="contactUsForm" lay-filter="contactUsForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="contactId" type="hidden"/>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">公司名称<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="name" name="name" placeholder="请输入公司名称" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">公司地址<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="address" name="address" placeholder="请输入公司地址" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">LOGO<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <div class="layui-upload-list"  id="changeImg">
                                <img class="layui-upload-img changeImg" id="demo1" class src="${ctxPath}/assets/common/images/blank.png" >
                                <p id="demoText"></p>
                                <input id="logo" name="logo" placeholder=""  type="hidden" class="layui-input"/>
                            </div>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">官方网址<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="website" name="website" placeholder="请输入官方网址" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">客服电话<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="servicePhone" name="servicePhone" placeholder="请输入客服电话" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">微信号码<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="wechatNumber" name="wechatNumber" placeholder="请输入微信号码" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">QQ号码<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="qqNumber" name="qqNumber" placeholder="请输入QQ号码" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">联系邮箱<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="email" name="email" placeholder="请输入联系邮箱" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>

</form>

@}